The relationship between diabetes management and preventing cardiovascular events was a theme throughout 2018, and this is reflected in the new standards.
This week, the American Diabetes Association (ADA) released the 2019 Standards of Medical Care in Diabetes, its annual update of clinical practice recommendations that includes guidelines and statements released during the previous year.
Throughout 2018, leaders in diabetes care have emphasized how disease management prevents cardiovascular events, and this was reflected in the latest Standards of Care. Here are 5 things to know about the ADA Standards of Care:
1. Collaboration between the ADA and the American College of Cardiology (ACC) is stronger than ever. The ADA endorsed the use of the ACC’s atherosclerotic cardiovascular disease (ASCVD) risk calculator for certain patients with type 2 diabetes (T2D) and chronic kidney disease, and the ACC endorsed the ADA chapter on cardiovascular disease management. This comes less than a month after ADA similarly endorsed ACC’s new consensus pathway on treating patients with T2D and ASCVD.
2. The new guidelines feature details on using newer T2D therapies with CVD benefits. Specifically, the ADA discusses the use of sodium glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, with and without heart failure. A new recommendation discusses benefits of SGLT2 inhibitors and GLP-1 receptor agonists for patients with chronic kidney disease.
3. Insulin is no longer the first injectable recommended in T2D. The ADA now recommends that most patients start with a GLP-1 receptor agonist; if more glycemic control is still needed, patients with T2D can add insulin or try one of the new combination therapies now available. The Standards of Care repeat ADA’s statement from earlier in the year about reining in the cost of insulin and making sure that insulin prices do not threaten diabetes management.
4. The 2019 Standards of Care carry forward a recent statement on hypoglycemia. Specifically, the statement with the European Association for the Study of Diabetes emphasized the need to factor in comorbidities, such as ASCVD, heart failure, or chronic kidney disease, as well as factors such as weight, patient age, and the cost of medication in decision making on management of hypoglycemia.
5. Patient preferences and personalization count. Throughout the document, which also covers medical nutrition, technology, and physical activity, there is an emphasis on customizing regimens that patients can embrace, manage, and afford. Physicians are encouraged to engage patients in shared decision making and not allow “therapeutic inertia” to creep into care, thus preventing patients from achieving optimal health.